Hi everyone, this lesson is on sharp Conjunctivitis. So, conjunctivitis, if we were to really 

Shiver downward the talk, conjunctiva refers to the conjunctiva of the eyes, and the suffix -itis refers to inflammation. So, sharp Conjunctivitis is a pain of the conjunctiva of the eye, and sharp Conjunctivitis is also noted as Pink Eye, and it’s noted as Pink Eye being this action  is described by a red or a pink eye. But not full red or pink eyes are conjunctivitis, so that’s also big to form a note of as well.

Viruses and Other Organisms Causing Conjunctivitis

We can also see varicella virus causing conjunctivitis as well. Some other viruses that are less common include enterovirus 70 and some pox viruses like molluscum contagiosum virus. And then there are other organisms that can infect the conjunctiva. We’re not going to talk about those in this lesson, and these include fungi and protozoa as well.

Pathophysiology Overview

So, we’ll now briefly talk about the pathophysiology. So, again, we split it into the different categories of causes we talked about before. Again, allergic is one of those types of conjunctivitis we talked about. So, in allergic conjunctivitis, it’s not going to be an infective organism that we had listed in the previous slide; it’s going to be an allergic response. 

Infective Organisms and Flora Disruption

And then with regards to infective organisms, there’s going to be alteration or disruption of the normal flora in some way, and then there can be adherence of pathogenic organisms to the conjunctiva. 

Risk Factors for Bacterial Conjunctivitis

So, frank  meaning that you have an express contact with that individual, or if it’s indirect, it could be where the decayed lone has melted their eyes and upset other objects in the environment, and then that person comes along and touches those same objects and then touches their eyes. That could be a way to get this indirectly. Contact lens use is going to be another risk factor for getting bacterial conjunctivitis, and then we can also see it with prior trauma, trauma to the eye or a previous eye condition.

Viral Conjunctivitis Contagiousness and Risks

And with viral conjunctivitis, this is going to be highly contagious. It’s going to be even more contagious than bacterial conjunctivitis, and it’s indeed going to be contagious as long as the eyes are red. So, this action can be contagious for weeks, and again, the risk factors are going to include direct and indirect contact with an infected individual. So, this is going to be even more key with growing  conjunctivitis, and if a patient has an upper respiratory tract infection like a simple cold or they’re in meeting with someone with an high respiratory tract infection, this also is a risk factor, as well, as top respiratory tract infections are like with viral conjunctivitis.

Hypersensitive Conjunctivitis disorder

So, let’s lecture about hypersensitive conjunctivitis disorder. We’re going to hole down the disorder relative to the group of conjunctivitis. The first type we’re going to talk about is hypersensitive conjunctivitis. So, hypersensitive conjunctivitis is going to arise bilaterally. This is going to be a systemic condition. The patient’s going to have more systemic signs and symptoms like sneezing, runny nose because it’s going to be an allergic response, and because of that, they’re going to have both of their eyes being affected.

Signs of Allergic Conjunctivitis

So, they’re going to have it bilaterally, so they’re going to have eye redness, and they may have some conjunctival injection. This is where we see blood vessels in the whites of the eye, and what’s going to be key with allergic conjunctivitis is itching. So, thirst is going to be the device finding because this is an hypersensitive response with histamine release. It’s going to be very itchy for the patient, so they’re going to be scratching their eyes, and they could also be rubbing their nose or sardonic as well.

Additional Allergic Conjunctivitis Features

And this allergic conjunctivitis is going to have tearing and runny eyes, and the discharge is going to be clear or watery. They may also have chemosis. Chemosis is where the conjunctiva itself becomes edematous, so there’s swelling or edema. So, you can see in this image here the conjunctiva becomes swollen, and they may have a little bit of eye burning, perhaps from the rubbing or from the itching, but there’s no pain.

Associated Allergic Conditions

And then there’s, again, associated symptoms because this is due to allergic responses to some allergen, so they’re going to have mucus production and sneezing, and the associated conditions with allergic conjunctivitis include allergic rhinitis, so hay fever, asthma, and atopic dermatitis. So, these are running to be the atopic triad.

Bacterial Conjunctivitis disorder

Now, emotional on to bacterial conjunctivitis. Bacterial conjunctivitis symptoms: bacterial conjunctivitis is more fair to be unilateral, despite it could be bilateral in some cases. So, again, we’re going to see eye bloom, and we can see conjunctival injections, so we can see these blood vessels.

Symbols of Bacterial Conjunctivitis

Here’s another icon of bacterial conjunctivitis with Chlamydia neutral infection. There can also be itching in some cases, so it’s not going to be a hallmark finding like we see in allergic conjunctivitis. They may have some tearing as well, and they’re going to have eye discharge that is going to be more purulent, so purulent meaning that it’s going to be pus-like, so it’s going to be white, green, and yellow in appearance.

Key data: Eyelids Glued Shut

And there can be so much eye pardon that a patient, when they fall asleep and they wake up in the morning, their eyelids can be stuck together, or what we would call glued shut in the morning. So, all of that discharge can get seasoned when they’re sleeping, and their blind get fast together, and they can’t open their eyes; their eyes get shut. So, this is running to act as a key info with bacterial conjunctivitis.

Snags of Bacterial Conjunctivitis

So, these are going to be more characteristic findings of a bacterial keratitis, and then there can be even other snags of bacterial conjunctivitis as well, including vision loss and blindness that may occur in very severe cases, and then in some cases, ocular perforations.

Some of these more strict snags can develop in Chlamydia and gonorrheal conjunctivitis cases.

Aggressive Conjunctivitis Symptoms

Now, let’s lecture about aggressive  conjunctivitis. The symbols and disorder of viral conjunctivitis can occur unilaterally or bilaterally, so they can arise on one side or the other, one eye or both eyes. So, again, we’re going to see eye redness, and with aggressive conjunctivitis, we’re going to more regularly see germ.

Germ in aggressive Conjunctivitis

So, follicles are going to be these scant inflated areas that we see, so these scant  bumps. So, we can see this in aggressive  conjunctivitis, but we could also see it in hypersensitive conjunctivitis as well.

Additional aggressive Conjunctivitis disorder

There may be some itching, although, again, this is going to be a less common finding. There can also be tearing, and what’s going to be important here is that there’s going to be a foreign body sensation. So, oftentimes patients are going to feel burning or a gritty sensation like sand in the eyes, so this can be something that can be noted as well.

Aggressive  Conjunctivitis pardon and wetness

And then the discharge in aggressive conjunctivitis is going to be damp or serous, and in some patients, this eye pardon can edge to some eyelid wetness as well.

So, like bacterial conjunctivitis, the blind can start to stick together, specially in the morning when they first watch up, but the blind  are not going to be as fast  as they are in bacterial conjunctivitis.

So, there can be a little bit of stickiness but not as bad as bacterial conjunctivitis.

Pre-auricular Lymphadenopathy in Viral Conjunctivitis

And we can also see pre-auricular lymphadenopathy. This is running  to be a typical data  in aggressive  conjunctivitis, so pre-auricular lymphadenopathy is an inflated, supple lymph node in the front of the ear.

This is the pre-auricular lymph node in this location here, so that could also be swollen and tender as well in viral conjunctivitis.

Eye Pain and Irritation in Viral Conjunctivitis

And there may be eye pain or irritation, especially if the viral conjunctivitis is caused by herpes simplex virus, but most of the time, it is not going to have eye pain or irritation except for that burning sensation or gritty sensation we can see with the foreign body sensation.

Association with Upper Respiratory Tract Infection

And as we mentioned before, viral conjunctivitis may be associated with an upper respiratory tract infection, so it could be that a patient has viral conjunctivitis first and then they go on to having an upper respiratory tract infection like a common cold, or they may have already had an upper respiratory tract infection and then once that has resolved, then they have this viral conjunctivitis after.

So, this is, again, identical with a top  respiratory plot infection.

Aggressive  Keratoconjunctivitis Overview

So, once the cornea becomes involved, there can be some other signs and symptoms as well.

Symptoms of Viral Keratoconjunctivitis

These include eye pain, vision loss or vision distortion, photophobia like light sensitivity.

So, these are going to be similar to the bacterial keratitis we saw before, increased eye redness, so it’s going to be more inflammatory, there’s going to be more inflammation, and the discharge here may become purulent, so the discharge can be more purulent in viral keratoconjunctivitis.

Importance and Causes of Viral Keratoconjunctivitis

And viral keratoconjunctivitis is going to be very important because there is potential for vision loss from it, and it’s going to be caused by infection with adenovirus serotypes 8, 11, 19, and 37 and herpes simplex virus.

Types of Discharge in Different Conjunctivitis

Different types of conjunctivitis: so a quick way to remember the different types of conjunctivitis can be by the discharge that we can see from the conjunctivitis.

So, with allergic conjunctivitis, this is going to be an easy one to spot because it is due to some allergen, and there’s going to be associations with sneezing, mucus production, and other atopic triad conditions.

So, the discharge is running to be watery or flowing or mucoserous, so this can be something that can be noted in hypersensitive conjunctivitis.

In bacterial conjunctivitis, the pardon is going to be corrupt, so we can see this corrupt white, yellow, or green discharge, and the eyelids are going to be glued together in the morning.

In Chlamydia and gonorrheal conjunctivitis, we didn’t talk about this in much detail, but the discharge is going to be slightly different.

It’s running  to be mucopurulent, so it’s running to be bile and corrupt, so there’s going to be a combination of the two.

And then in aggressive conjunctivitis, it’s running to be serous and watery, and in some cases, if it is due to herpes zoster virus, we didn’t talk about this before, but if it is due to aids zoster virus, it can be mucopurulent, and if it is an aggressive keratoconjunctivitis, we may see a more purulent pardon as well.

Analysis of Conjunctivitis Types

Let’s talk about how the different types of conjunctivitis are analyze. Most of them are going to be by clinical diagnosis, so just looking at the history and physical examination, the clinician can often make a diagnosis of the different types of conjunctivitis.

But more specifically, if we’re to actually do some different tests and procedures, with allergic conjunctivitis, superficial conjunctival scrapings may be utilized, and this may help in the diagnosis of allergic conjunctivitis.

In bacterial conjunctivitis, it could be again by clinical diagnosis or could be by a bacterial culture, conjunctival scrapings, a gram stain.

So, the gram stain can help determine if it is caused by a gram-positive or a gram-negative bacteria.

A Giemsa stain can be used to detect intracellular inclusion bodies from Chlamydia, so if there is some question of whether or not this is a chlamydial conjunctivitis, a Giemsa stain is going to be important.

And with bacterial conjunctivitis, we’re going to see high neutrophils when we look at some of those scrapings.

And I didn’t mention this before, but in allergic conjunctivitis, we’re going to see high levels of eosinophils.

And then in viral conjunctivitis, we can also do a culture and conjunctival cytology smear only usually in severe, recurrent, or refractory cases.

And then there is a kit that can be used called AdenoPlus amino acid to detect for adenoviral conjunctivitis, again, this is going to be the most common type of conjunctivitis.

And then we can also use a fluorescein stain if there is viral keratoconjunctivitis, so this can help determine the involvement of the cornea.

This fluorescein stain, and we can see high lymphocytes in the conjunctival smear in viral conjunctivitis.

Treatment of Conjunctivitis

Antihistamines can help as well.

Cold compress, so cold compression of the eyes can help with some of those symptoms.

Topical corticosteroids may be used in some cases and artificial tears.

With regards to viral conjunctivitis, viral conjunctivitis usually resolves spontaneously within two weeks, and it could be up to four weeks, and in the meantime, cold compress and artificial tears can be a supportive treatment.

In some cases, though, if it is going to be caused by herpes simplex virus or some other more severe virus or causes a more severe case of viral conjunctivitis, ganciclovir and acyclovir may be used in those cases, and then glucocorticoids may be used in the case of keratoconjunctivitis, especially if there is a lot of inflammation due to that viral keratoconjunctivitis.

And with regards to bacterial conjunctivitis, again, this is usually a self-limiting infection lasting one to two weeks, but what’s going to be most helpful is if the patient gets broad-spectrum antibiotic eye drops.

So, these are going to be topical antibiotic eye drops that are used. This can help resolve the bacterial conjunctivitis quite quickly, and then in some very severe cases, if there are systemic signs and symptoms from this bacterial infection, systemic antibiotics may be used, and again, it’s going to occur in severe cases or in cases involving neonates, in children, and especially for chlamydial and gonorrheal infections.

Again, these are going to be the causes of very severe complications in some individuals.

Conclusion and Thanks

I hope you begin this lesson helpful. If you did, please like and sign up for more instructions  like this one, and as always, thanks for alert and goal to see you next time!